Project Summary/Abstract Severe acute respiratory failure is the most common organ failure in the intensive care unit, the most severe form of which is acute respiratory failure syndrome. Understanding and preventing the long-term physical and cognitive impairments that is the legacy of surviving acute respiratory failure (ARF) is the career goal of this junior minority investigator with previous clinical training in Pulmonary, Critical Care and research training in Clinical Epidemiology. Although previous research in ARF has examined mobility outcomes independently from the cognitive outcomes, emerging evidence suggests that mobility and cognitive outcomes are intertwined. Cognitive Motor Interference (CMI) is an emerging risk assessment and treatment approach for improving disability outcomes in many patient populations. Dr. Hope describes a mentored research project and specific career development plan which will enable him to become an expert in CMI assessments in patients with acute respiratory failure. The research proposal aims to leverage the NHLBI funded Prevention and Early Treatment of Acute Lung Injury (PETAL) network to define the scope, pattern and predictive validity of assessing acute respiratory failure patients for CMI while in the hospital. The research proposal's second aim is to conduct a single-center randomized clinical trial of hospital based CMI-based training in acute respiratory failure patients. During the award period, Dr. Hope has developed a structured plan to build on his previous training by attaining skills in four additional areas: 1) measuring cognitive motor interference in acutely ill patients; 2) understanding and intervening on disability outcomes after critical illness; 3) the management of clinical trials and 4) structured equation modeling. As part of this career development award, Dr. Hope will be a co-Principal Investigator for PETAL network studies at his institution and will serve as site Principal Investigator for an NHLBI funded ancillary study called PRIMROSE. As a member of the PETAL Network Long-Term Outcomes Working Group Committee, he will be involved, along with his mentors and collaborators, with developing recommendations for measuring long-term outcomes in the PETAL network studies. Dr. Hope will work closely with co-mentors in Neurology, Geriatrics and Critical Care with expertise in cognitive and mobility outcomes; He will also work with advisors and collaborators in Rehabilitation Medicine with expertise in the disability process in acutely ill patients. Through a mix of formal and informal coursework, practical experience, local and international meetings along with directed feedback from this multi-disciplinary team of mentors and advisors, Dr. Hope will be prepared to become an independent investigator by the end of this award period.